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OSCE > Gastro/Endocrine/Renal/Haem > Flashcards

Gastro/Endocrine/Renal/Haem Flashcards

1
Q

What are some specific symptoms you should ask about in a GI history?

A

Dysphagia/odynophagia, nausea/vomiting/haematemasis, abdominal pain/bloating, altered bowel habit/PR bleeding, jaundice

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2
Q

If a female patient presents with abdominal pain, what other things must you remember to ask them?

A

Is there any chance they could be pregnant? - remember to screen for gynae/obstetric problems

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3
Q

If a patient presents with jaundice, what are some extra things to ask about?

A

Have they travelled abroad recently? Have they had any tattoos/piercings recently? Have they had unprotected sex recently? (particularly new partner/high risk activity)

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4
Q

What gastrointestinal conditions can finger clubbing be a sign of?

A

IBD, cirrhosis, coeliac disease

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5
Q

What is leuconychia a sign of?

A

Hypoalbuminaemia

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6
Q

Scleral icterus implies a serum level of bilirubin greater than what?

A

35

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7
Q

Where is Virchow’s node and what is the significance of it?

A

Left supraclavicular area - suggestive of gastric cancer

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8
Q

The presence of how many spider naevi is suggestive of chronic liver disease?

A

5 or more

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9
Q

In addition to oedema, what are some extra skin changes to look for on the calves of someone with potential gastrointestinal disease?

A

Erythema nodosum or pyoderma gangrenosum

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10
Q

How do you assess for shifting dullness?

A

Percuss from the umbilicus to the opposite flank- if dullness is detected, ask the patient to roll towards you, wait 10 seconds and the re-percuss

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11
Q

The presence of shifting dullness suggests what?

A

Ascites

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12
Q

Where should you auscultate for bowel sounds?

A

Just below the umbilicus

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13
Q

Where should you auscultate for renal bruit?

A

Superior and lateral to the umbilicus

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14
Q

Where should you auscultate for aortic bruit?

A

Superior to the umbilicus

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15
Q

After finishing an abdominal examination, you may wish to mention that you would perform which further examinations?

A

Hernial orifices, PR, male/female genitalia

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16
Q

Where will a transplanted kidney be found?

A

Right or left iliac fossa

17
Q

If you suspect fluid overload in an individual with gastrointestinal/renal disease, what is a useful thing to examine out with these systems?

A

Lung bases for pulmonary oedema

18
Q

What is the ideal position for a patient to be in when you examine for hernias?

A

Standing upright

19
Q

What should you always ask patients to do when examining a possible hernia?

A

Cough

20
Q

What are the main symptoms you should ask about during a urological history?

A

Dysuria, haematuria, frequency/nocturia, incontinence, urgency, hesitancy/poor stream/terminal dribbling

21
Q

What are the main symptoms you should ask about if you suspect haematological disease?

A

Shortness of breath/dizziness/pallor, bleeding/bruising, recurrent infections and systemic symptoms

22
Q

If you are asked to do a warfarin review, what are the first things you should clarify?

A

Why are they on warfarin and what is their INR

23
Q

When should warfarin be taken?

A

At the same time every day

24
Q

What should you advise patients to do if they miss one dose of warfarin?

A

Take it as soon as they remember, unless it is the next day in which case the dose should be omitted and they should contact their doctor

25
Q

When patients start warfarin, you should inform them to seek help if they experience what skin changes?

A

Jaundice or painful, swollen areas of skin

26
Q

What are some examples of foods that decrease the effect of warfarin (increased risk of clotting)?

A

Kale, broccoli, spinach

27
Q

What are some examples of foods that increase the effect of warfarin (increased risk of bleeding)?

A

Cranberry and grapefruit juice, alcohol

28
Q

What should you do if a patient on warfarin has an INR of 5-8 but is not actively bleeding?

A

Withhold 1 or 2 doses of warfarin and reduce the maintenance dose

29
Q

What should you do if a patient on warfarin has an INR of 5-8 with minor bleeding?

A

Withhold warfarin, give an IV injection of vitamin K, restart warfarin when INR is < 5

30
Q

What should you do if a patient on warfarin has an INR > 8 but is not actively bleeding?

A

Withhold warfarin, give oral vitamin K, restart when INR is < 5

31
Q

What should you do if a patient on warfarin has an INR > 8 with minor bleeding?

A

Withhold warfarin, give IV injection of vitamin K, restart warfarin when INR is < 5

32
Q

What should you do if a patient on warfarin experiences major bleeding?

A

Withhold warfarin, give IV vitamin K, give IV prothrombin complex concentrate or FFP

33
Q

What specific symptoms should you ask about in a CKD review history?

A

Ankle swelling, itch, nausea/vomiting, urinary symptoms, systemic symptoms

OSCE (14 decks)

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